COMPARISON OF TOTAL PARENTERAL-NUTRITION AND AN ORAL, SEMIELEMENTAL DIET ON BODY-COMPOSITION, PHYSICAL FUNCTION, AND NUTRITION-RELATED COSTS IN PATIENTS WITH MALABSORPTION DUE TO ACQUIRED-IMMUNODEFICIENCY-SYNDROME

. Background: The nutrition management of patients with malabsorption syndromes due to acquired immunodeficiency syndrome (AIDS) is problema tic. The aim of this study was to compare the effects of total parente ral nutrition (TPN) and an oral, semielemental diet (SED) on body weig ht, body composition,, quality of life, survival, and medical costs in AIDS patients with malabsorption. Methods: This was a prospective, ra ndomized, open-label study performed in outpatients. Twenty-three AIDS subjects (TPN group, 12; SED group, 11) with cryptosporidiosis, micro sporidiosis, or malabsorption of unknown cause were randomized and fol lowed. Subjects were prescribed equivalent amounts of formulas of simi lar composition for 3 months. Monthly estimations of caloric intake, b ody weight, body composition by bioimpedance analysis, and quality of life were recorded. Nutritional variables were analyzed by repeated-me asures analysis of covariance, with the baseline measure as the covari ate. Nutrition-related medical costs, survival, and indices of absorpt ive and immune function were compared, Results: Subjects had lost an a verage of 1.5 and 1.0 kg body wt/mo for TPN and SED during the 6 month s before study entry (p < not significant). The TPN group consumed mor e total calories than the SED group (p < .05). Weight change during th erapy was significantly different from pretreatment in both groups (p < .01 for TPN, p = .023 for SED). The TPN group gained more weight tha n the SED group (p = .057) and significantly more fat (p = .02), but t he changes in body cell mass were similar in the two groups. Changes i n weight and body composition correlated with caloric intake but not t he mode of feeding. The SED group scored significantly better than the TPN group on a physical functioning subscale of quality of Life (p < .01). Survival was similar in the two groups. TPN therapy cost almost four times more than SED. Peripheral blood CD4+ lymphocyte numbers wer e unaffected by either therapy. Intestinal function was not affected b y either therapy. Conclusions: An oral SED may reverse weight loss and wasting in AIDS patients with malabsorption.